Page 12 - CEREC Q3|2013
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cerecdoctors.com
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quarter 4
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2013
important to sift through one’s notes
fromvariousCEandeducational courses
to reinforce concepts that, far too often,
are forgotten. The following state-
ments are intended to serve as a guide
to clinicians in the diagnosis, treatment
planning and management of patients
requiring dental implant therapy.
The following is the first of a quarterly
list of random pieces of information
that I have come across. I hope these will
betterprepareclinicians tomake informed
surgical and prosthodontic treatment
decisions that will further enhance
the quality of care and predictability of
is it just me, or do you also notice
that, as clinicians,we tend tocomeacross
random facts or “dentistry pearls” that
occasionally play a significant impact on
our day-to-day practice of dentistry?
At times, it is great to just chat with a
colleague or fellowdentist on things that
are working for them in clinical prac-
tice, business practice and marketing. I
often have the luxury and opportunity
to sit at the dinner table with some of
the world leaders and trendsetters in
implant dentistry. Over dinner, I usually
am silent, as it is my opportunity to be
a sponge for material and content. It is
In This Quarterly Column, the Author Shares Tips on Implantology
Pearls of Wisdom, Part 1
A d v i c e f o r C l i n i c i a n s
| | |
b y n e a l pat e l , d . d . s .
treatment outcome for their patients.
I consider these to be “pearls of
wisdom” that I wish to pass along to
my fellow CEREC dentists. There is no
rhyme or reason to them, and the only
thing they have in common is that they
will help you in your journey to being the
best CERECuser you canbe. Ultimately, I
anticipate that these simple — yet sophis-
ticated — statements will make as lasting
an impression on you as they have onme.
For questions or more information,
Dr. Patel can be reached at
.
Pat e l ’ s
p e a r l s
o f w i s d o m
Results of clinical, radio-
logic and histologic studies
indicate that bony healing
of extraction sites proceeds
with external resorption of
the original socket walls and
a varying degree of bone fill
within the socket.
Studies in humans and
animals have demonstrated
that a defect of 2 mm or
fewer between an immediate
implant surface and a bony
extraction socket wall will
likely fill with bone without
the need for augmentation.
In immediate implant
sites where the defect to
an extraction
wall is greater
than 2 mm or
sites which have
a non-intact
socket wall will likely require
augmentation using barrier
membranes and/or mem-
brane-supporting materials
to assist in guiding the graft
material and regeneration of
osseous tissues.
The general consensus of
antibiotic use in conjunction
with implant therapy is incon-
clusive. There is an agreement
that the use of antibiotics is
advantageous when augmenta-
tion procedures are performed.
There is an agreement based
on prospective clinical trials
that a single dose of antibiot-
ics prior to implant surgery
is effective in preventing
infection. When using antibi-
otic prophylaxis, an adequate
serum concentration should be
established within two hours
of the time of surgical incision
and should not be continued
for more than 24 hours, as
it may encourage growth of
resistant organisms.
With patients who
present with a thin biotype
and immediate implant place-
ment, extra care should be
taken to augment the implant
site concomitant to immedi-
ate implant placement in
anticipation of buccal plate
resorption and marginal
tissue recession. If buccal
plate integrity is lost in the
thin biotype patient, immedi-
ate implant placement should
be aborted and augmentation
therapy becomes the focus.
There is a general consen-
sus among leading implant
surgeons that the 3-D posi-
tioning of the implant should
be restoratively driven. One
can avoid prosthetic compli-
cations by simply following
a protocol that establishes
restorative goals prior to
engaging in implant place-
ment and using the restor-
ative vision to aid in place-
ment of the implants.
The majority of articles
indicate that good bone
quality, primary implant
stability and splinting of
implants in cases of immedi-
ate and early loading are
recommended, even though
no uniform criteria to
evaluate these parameters
has been used.
Immediate loading
(as opposed to early and
delayed loading) of full-arch
mandibular fixed prosthesis
and overdentures supported
by rigidly connected implants
between the mental foramina
is routine, and has a base of
clinical evidence.
Early loading of implants
placed in the mandible, both
with overdentures and fixed
prosthesis, seems to be a
reliable technique; but more
research is needed before
proposing this technique as
routine.
